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8/10/2019 How to Manage Vascular Disease Cp - Dr Sahal Fatah
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How To Manage Vascular Surgery in Semarang
Sahal FatahDiponegoro University
KARIADI HOSPITAL
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20141929 1960
Era of diagnostics
Cardiac and vascular diagnostic
procedures were rapidly developed
(Table 1.1)
Era of therapeutics
Development of interventional
modalities such as embolectomy,
angioplasty, and atherectomy(Table 1.2)
Evolution of Endovascular Therapy: Diagnostics and
Therapeutics Thomas J. Fogarty and Amitava Biswas
Endovascular therapy is the manipulation ofpathology by an intraluminal approach
Historyof endovascular therapy can be dividedinto two 30-year periods.
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Evolutionof Endovascular
Diagnostics and Therapeutics
Evolution of Endovascular Therapy:
Diagnostics and Therapeutics
Thomas J. Fogarty and Amitava Biswas
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Era of Diagnostics
(19291959)
The surgeon Renaldo Dos Santos,
breakthrough applied to the extremities and to
develop arteriography and aortography
Forssmann should be possible to insert a
catheter into the right side of the heart through a
venous channel and thereby:
monitor cardiac pressures obtain blood for analysis, and
administer therapeutic agents
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Renaldo Dos Santos, MD,
Pioneer surgeonand original
developer of diagnostic arterial
visualization techniques and
technologies
Werner Forssmann, MD,
Physician credited with developing
endovascular diagnostics by
demonstrating cardiac assessment
using catheter
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Werner Forssmann inserting acatheter into his antecubital vein
1956 Nobel Prize in Medicine
http://en.wikipedia.org/wiki/Nobel_Prize_in_Medicinehttp://en.wikipedia.org/wiki/Nobel_Prize_in_Medicine8/10/2019 How to Manage Vascular Disease Cp - Dr Sahal Fatah
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Sven Ivar Seldinger
A radiologist from Sweden. He
introduced technique to obtain safe
access to blood vessels and other
hollow organs
Andr Frdric Cournand
A Surgeonswho is known for cardio
catheterizationNobel Prize in Physiology or Medicine
the Anders Retzius Silver Medal of theSwedish Society for Internal Medicine
http://en.wikipedia.org/wiki/Nobel_Prize_in_Physiology_or_Medicinehttp://en.wikipedia.org/wiki/Nobel_Prize_in_Physiology_or_Medicine8/10/2019 How to Manage Vascular Disease Cp - Dr Sahal Fatah
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Era of Therapeutics
(19601990)
Embolec tomyFogarty The earliest disease
entity to be approached intraluminally was
embolic occlusion.
Balloon Angiop lasty
Dotter/Grntzig useda balloon catheter made by Fogarty to
expansion of the balloon caused an increase
in the lumen diameter (iliac stenosis). AtherectomySimpsondeveloped the idea
of mechanically removing atheroma from
vessels lumen (atherectomy).
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Charles Theodore Dotter
RadiologistThe Father of
Intervention. Described angioplasty
in 1964
Dr. Thomas J. Fogarty
An American CardioVascular surgeon
inventor of the embolectomy catheter
for removing an embolus, or blood clot
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Andreas Roland Grntzig
A German Cardiologist who first
developed successful balloon
angioplasty for expanding lumens of
narrowed arteries
Julio Palmaz
Doctor of vascular radiology. He
got the idea for his stent after
listening to a lecture by Gruentzig
at a conference in New Orleans in
1978.
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Juan C. Parodi, MD,
Vascular surgeon and designer
who advanced the clinical
techniques and applications for the
transluminally placed endovascular
endograft
John B. Simpson, MD,
Cardiologist and innovator
of catheter-mediated techniques for
treating coronary artery
atherosclerosis
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Future Developments
The users of the new technology are often
shared by multiple specialties. In the
endovascular field we have :
Cardiologists Cardiothoracic and Vascular Surgeons
Vascular surgeons
Interventional radiologists
All threating the same diseases and pathology withthe same or different techniques and instruments.
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Indonesia
Indonesia has only one vascular surgery
program in Jakarta.
and had two cardiovascular thoracic surgery
program in Jakarta and Surabaya.
240 Millionof population
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Live
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Endovascular is the
responsibility of the
Cardiothoracic and Vascular Surgeon
Vascular Surgeon
Cardiologist
Radiologist
DO NOT BLAME EACH OTHERS
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Endovascular therapy is a multidisciplinary
field
involving contributions from surgeons,
cardiologists
radiologists, physicists, and engineers.
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Indication of Endovascular
CHRONIC LIMB ISCHEMIA : Arteriografi, PTA Stent graft ACUTE LOWER LIMB ISCHEMIA : Thrombolysis , Thromboembolectomy
CAROTID AND VERTEBRAL DISEASE : Angioplasty and stenting
VISCERAL ARTERY OCCLUSIVE DISEASE : Angioplasty and Stenting
THORACIC and ABDOMINAL AORTA : ANEURYSMS AND DISSECTIONS
VISCERAL AND PERIPHERAL ANEURYSMS : Endovascular grafting
VASCULAR MALFORMATIONS : Embolization, coiling
VASCULAR TRAUMA : Arteriografi, Embolization
VENOUS DISEASE : IVC filter, Venoplasty, stenting
ARTERIOVENOUS ACCESS
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Advantages and Disadvantages
Endovascular
Advantages
Less invasive
Less hospital length of stay Less morbidity and mortality
Disadvantages More expensive
Indonesia
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Indonesia
Hospitals TEVAR and EVAR*
Peripheral
endovascular
diagnostic and
treatment **RSPJN Harapan Kita Jakarta Cardiologist
Thoracic Cardio-Vascular
RSUPN Cipto
Mangunkusumo Jakarta
Vascular Surgery
Cardiovascular Consultan
RSUP dr Kariadi Semarang Thoracic Cardio-Vascular
Surgery
Intervention Radiology
RSUD dr Soetomo Surabaya Cardiologist
Intervention Radiology
RSUD Sanglah Denpasar Thoracic Cardio-Vascular
Surgery
RSUD Dr. Moewardi Solo Thoracic Cardio-VascularSurgery
RSUD Dr. Zainal Abidin
Aceh
Thoracic Cardio-Vascular
Surgery
* Thoracic-Abdominal Aneurism and Dissecting
** Arteriography, PTA, Stenting
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Taiwan
Vascular surgery only gained recognition as a specialty inthe mid-2000s, when the Taiwan Society for Vascular
Surgery was established.
Prior to this endovascular work was largely in the hands of
cardiologists.
There has been a significant volume of carotid and
vertebral angioplasty and stenting done by the Division of
Cardiology at the National University of Taiwan Hospital.
EVAR development was late in Taiwan due to government
regulations mandating a FDA-type trial before any devicescan be registered for use.
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Vascular surgery practiceis mainly confined to
two university hospitals
and the rest are performedby general surgeons.
Affordable health care
for all citizens are provided
but expensive devices
were not included;
i.e. endografts and stents.
In general, peripheral endovascular surgery is still notpopular due to reluctance of the patients to undergo
intervention and to pay for expensive devices. Endovascular stent graft remained at this time largely
in the hands of surgeons, working in operating roomsetting either individually or in cooperation withradiologists.
Hong Kong
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Thailand
Endovascular surgery has also proliferated
significantly in Thailand in the last few years.
Initially supported and reimbursed by the
government, covering 80% of device costs, there has
been a rapid growth of endovascular stent grafts, butat significant expenses to the government
Malaysia
EVAR and other endovascular surgery is limited to avery few private vascular surgeons who have the
facilities and the patients to afford the devices.
Currently this remains a very small market.